What Should I Do If My Breast Tissue Expander Breaks Or Leaks?

Steps to Take if Your Breast Tissue Expander Ruptures

Tissue Expander, Round with Internal Port
What should you do if your breast tissue expander ruptures?. Art © Pam Stephan

What should you do if your breast tissue expander ruptures or leaks? What are the causes of this complication, what symptoms might you expect, and how is it treated?

Breast Tissue Expanders - A Little Background

Breast tissue expanders are implantable, balloon-like devices used in breast reconstruction surgery. A tissue expander is used to stretch breast skin and chest wall muscles in order to create a pocket for a permanent breast implant.

Expanders may be implanted at the time of your mastectomy, or later on if you choose to have breast reconstruction surgery.

As with all types of surgical devices, tissue expanders come with some risk, the most common being ruptures or leaks. Don't panic if you think that your tissue expander has broken or sprung a leak—there’s a good solution—but do consult your surgeon if you think there's a problem. Let's look at the causes, symptoms, and solutions for a broken or ruptured breast tissue expander.

Causes Of Breast Tissue Expander Leaks and Ruptures

Breast tissue expanders are designed to be filled with saline solution and to hold that saline for as long as you need it, to make room for a permanent breast implant, either silicone or saline. A leak or a rupture interrupts the process of tissue expansion, so it must be taken care of properly.

Some of the causes of tissue expander rupture are:

  • Puncture during surgery - This could be due to implant surgery or related breast surgery.
  • Compression during a mammogram - If a technician applies too much pressure, an expander may pop and drain.
  • Injury to the area - Accidents happen in sports, other physical activities, or crowded situations.
  • During expansion treatment - A needle puncture, improper filling technique, or overfilling of saline solution may result in a leak or rupture.
  • Valve leak - Even though expanders are carefully inspected, some may have an unsealed or damaged valve that could leak.

How Often Do Tissue Expanders Rupture

The chance that a tissue expander will rupture depends on many factors and is different for each woman. That said, the longer the expander is in place, the greater the chance of rupture. In a 2016 study it was noted that among those with tissue expanders, no ruptures were noted during the first year. An increased risk began around 1.5 years after placement and rose to 32.6 percent at three years and 55 percent at five years following placement of the expander.

Other studies have looked for other risk factors. Those who have a body mass index greater than 25 kg/mm2 and those who have a seroma which requires aspiration appear to have an increased risk of rupture.

Symptoms And Diagnosis Of Breast Tissue Expander Leaks and Ruptures

The symptoms of a rupture or leak in a tissue expander could include the gradual or sudden decrease in size or a change in shape of the implant area. Your surgeon should examine the area and will most likely refer you for an imaging study, such as a breast MRI, a mammogram, or an ultrasound.

An expander which is leaking or ruptured needs to be removed.

So if you think your expander has ruptured or leaked, you'll need to get it professionally checked out. One good reason to do this is that insurance may not cover expander replacement unless a rupture can be medically documented.

Other Potential Problems With Tissue Expanders

In addition to leaks and ruptures, there are a few other problems associated with tissue expanders:

  • Infection - The introduction of bacteria during placement of an expander may result in an infection. This is more likely to occur if you have been immunosuppressed due to chemotherapy, and especially if you undergo radiation therapy. If you will be having radiation therapy after having a tissue expander placed, talk to your doctor about this risk. A tissue expander which becomes infected must be removed.
  • Capsular contracture - Capsular contracture may occur due to the presence of scar tissue which forms around the tissue expander. Symptoms may include firmness and hardening of your breast tissue around the expander.
  • Pain - Some people note significant pain with tissue expanders, and most people will find that they feel more comfortable once the permanent implant replaces the expander. Tissue expanders have a thicker and less flexible shell that permanent implants. Pain usually worsens following each fill, due to stretching of the tissue surrounding the expander (the purpose of having the expander in the first place.)

A Broken Tissue Expander Must Be Replaced

After checking your breast tissue expander and having confirmation of a break or leak with medical imaging, it's time to take action. The saline that leaks out won't harm you, but the tissue expander can become infected. Tissue expanders can't be repaired within your body, and it isn't safe to remove, repair, and reinsert an old expander. These devices are meant for one-time use, not for re-use. A broken or leaky tissue expander must be surgically removed and replaced. If your body is ready for the permanent breast implant, then the permanent implant can become the replacement for the failed tissue expander.

Coping With a Tissue Expander Rupture

Facing removal and replacement of a tissue expander can be emotionally draining as it adds yet one more procedure to the challenging treatment of breast cancer. Studies suggest that depression after breast cancer is more prevalent with the occurrence of tissue expander complications; a condition already elevated after a diagnosis of breast cancer. In addition to removal and replacement of the expander, it's important that you seek support from family and friends. Some people find it very helpful to talk with a cancer therapist as well, and psychological therapy following a diagnosis and treatment for breast cancer has even been linked to improved survival in some studies.

Bottom Line on Tissue Expander Leaks and Rupture

Tissue expanders are used often following a mastectomy to stretch your tissues allowing for a permanent breast implant. These expanders aren't fool-proof, and leaks and ruptures may occur either due to puncture, compression, or injury to the area. While implants are carefully inspected before use, products may be faulty as with any medical device.

If your implant leaks or ruptures, it will need to be removed and replaced with either another tissue expander or with your permanent implant if you have enough tissue to allow for this.

Tissue expanders may also become infected at times and can be uncomfortable. If you are feeling uncomfortable it may be of some reassurance that most women find that their permanent implants are much more comfortable than the expanders.

Sources:

Chuba, P., Stefani, W., Dul, C. et al. Radiation and Depression Associated With Complications of Tissue Expander Reconstruction. Breast Cancer Treatment and Research. 2017 May 13. (Epub ahead of print).

Ota, D., Fukuuchi, A., Iwahira, Y. et al. Identification of Complications in Mastectomy With Immediate Reconstruction Using Tissue Expanders and Permanent Implants for Breast Cancer Patients. Breast Cancer. 2016. 23(3):400-6.

Continue Reading